Provider Demographics
NPI:1477943801
Name:DICKEY, AMANDA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:DICKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:BRIGALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:57 WALTER ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6233
Mailing Address - Country:US
Mailing Address - Phone:207-299-0754
Mailing Address - Fax:
Practice Address - Street 1:21785 FILIGREE CT STE 100
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6214
Practice Address - Country:US
Practice Address - Phone:703-554-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95001802363LF0000X
VA0024172188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily